Annals of Pediatric Endocrinology & Metabolism最新文献

Purpose: Continuous glucose monitoring (CGM) technology offers real-time glucose feedback and has shown potential to improve glycemic control. This retrospective study evaluated the effect of CGM on glycemic outcomes in Korean children and adolescents with type 1 diabetes mellitus (T1DM) in a real-world setting.

Methods: We included 66 participants divided into a CGM group (n=22) and a self-monitoring blood glucose (SMBG) group (n=44). We compared changes in hemoglobin A1c (HbA1c) of the 2 groups over 1 year and observed changes in CGM activation time, mean glucose, glucose management indicator (GMI), coefficient of variation (CV), time in range (TIR), and hypoglycemia.

Results: The CGM group had a mean age of 16.63 years and time from diagnosis to the initiation of study of 4.19 years, while those of the SMBG group were 17.85 years and 5.19 years, respectively. In the CGM group, mean HbA1c decreased from 8.68% at baseline to 7.92% at 12 months (P=0.011), whereas HbA1c increased from 8.46% to 8.93% in the SMBG group (P<0.001). The changes in HbA1c at 1 year between the CGM and SMBG groups were significantly different (-0.76%±1.39% vs. 0.47%±1.38%, P=0.001). CGM activation time decreased slightly (89.09% to 79.24%, P=0.093), and there were no significant changes in TIR, mean glucose, GMI, CV, or hypoglycemia over time.

Conclusion: CGM use in Korean children and adolescents with T1DM significantly improves HbA1c levels over 12 months compared to SMBG. The implementation of CGM may provide valuable benefits in glycemic control and potentially reduce the risk of diabetes-related complications.

Purpose: Both premature adrenarche (PA) and obesity are closely linked to increases in bone age (BA). However, the mechanisms underlying these associations are unclear as research data, particularly in boys, are lacking. Therefore, our aim in this study was to test for an association between obesity and BA progression in boys with PA and to assess the role of adrenal androgen in the mediation of any identified association.

Methods: We retrospectively analyzed data from medical records of prepubertal boys with PA. Participants were categorized into 2 groups based on the difference between their BA and chronological age (CA), BA-CA≥1 and BA-CA<1.

Results: Among 67 boys having a mean age of 8.3±0.7 years, the 27 boys in the BA-CA≥1 group had significantly higher body mass index (BMI) z-scores (1.7±0.9 vs. 1.0±1.3, P=0.022) and dehydroepiandrosterone sulfate (DHEA-S) z-scores (1.7±1.3 μg/dL vs. 1.1±0.7 μg/dL, P=0.020), than the 40 boys in the BA-CA<1 group. Multivariate regression analyses revealed a significant association between BMI z-score and BA progression for the BA-CA≥1 group, even after adjusting for DHEA-S z-score, odds ratio=1.605 with P=0.048. Mediation analyses indicated that the direct effect of BMI z-score on BA-CA was statistically significant, β=0.2190 with P=0.039; however, the indirect effect of BMI z-score on BA-CA through DHEA-S z-score was not significant.

Conclusion: In boys with PA, higher DHEA-S z-scores and BMI z-scores were associated with BA-CA. However, DHEA-S did not mediate the relationship between obesity and BA progression. Our data suggested that in boys with obesity and PA, the rapid progression of skeletal maturation is primarily the result of a direct impact of obesity on BA and not due to an increase in adrenal androgen levels.

Purpose: Diabetes distress is common in individuals with type 1 diabetes (T1D). Kindness to oneself may have positive effects on diabetes distress and glycemic control, but existing data supporting this theory are limited. This study examined the effects of a self-compassion intervention, remotely delivered, in adolescents and young adults with T1D.

Methods: Thirty-four participants, aged 18-30 years, were randomized to receive and complete a self-compassion intervention (n=16) or placed in a waitlist control group (n=17). The self-compassion group participated in 6 (12 hours over 12 weeks) virtual group meetings. After 12 weeks, the control group was offered the same intervention program. Then, diabetes distress (primary outcome), hemoglobin A1c (HbA1c), diabetes self-efficacy, self-compassion, depressive symptoms, stress, and self-reported sleep quality (secondary outcomes) were collected at baseline and 12 and 24 weeks.

Results: The mean±standard deviation age was 23.6±3.6 years, and 22 participants (64.7%) were female. At 12 weeks, there was no significant difference in diabetes distress between the 2 groups (P=0.876). However, the intervention group experienced a significant reduction in HbA1c compared to the control group (mean difference [MD], -0.51%; 95% confidence interval [CI], [-0.97 to -0.04]; P=0.035). Other secondary outcomes did not differ between the groups. At 24 weeks, compared to 12 weeks, the intervention group maintained their HbA1c reduction (7.33% [1.00] vs. 7.49% [0.95]; MD, 0.16; 95% CI, [-0.04 to 0.36]; P=0.118), while the waitlist control group showed an HbA1c reduction after receiving the intervention (8.34% [1.96] vs. 7.76% [1.46]; MD, -0.58%; 95% CI, [-0.95 to -0.20]; P=0.005).

Conclusion: A brief, online self-compassion intervention resulted in significantly improved glycemic control, although it did not reduce diabetes distress, in adolescents and young adults with T1D.

Purpose: Although insulin resistance (IR) varies with age and puberty in children and adolescents, most previous attempts to determine cutoff values for IR indices overlook factor. This study assesses age-related differences in IR index values and evaluates how diagnostic performance varies by age when using a uniform cutoff for diagnosing metabolic syndrome (MetS) without considering age.

Methods: We analyzed age-related differences in IR indices (the homeostatic model assessment of insulin resistance [HOMA-IR], triglyceride-glucose [TyG] index, and triglyceride/high-density lipoprotein cholesterol [TG/HDL-C] ratio) among 1,641 participants in the 2019-2021 Korea National Health and Nutrition Examination Survey. We also examined IR index values for diagnosing MetS in 1,574 participants.

Results: IR indices showed significant age-related variations in group-comparison tests, with a peak at ages 12-13 years in males and 11-13 years in females (P<0.001 for the HOMA-IR, P<0.005 for the TG/HDL-C ratio in both males and females, and P=0.003 for the TyG index in females). Applying a uniform cutoff derived from receiver operating characteristic curve analysis for diagnosing MetS showed substantial age-related variation in diagnostic accuracy, with standard deviation-to-mean ratios of age-specific accuracy of >10% for the HOMA-IR and >5% for the TyG index, while showing minor variation (<5%) for the TG/HDL-C ratio. Using age-specific percentiles for the HOMA-IR (80th of the general population) and TyG index (80th of those without MetS) reduced these variations to <5% while maintaining similar diagnostic performance.

Conclusion: This study highlights the importance of age-related variation in IR in children and adolescents.

Ever since its discovery, glucagon-like-peptide 1 (GLP-1) and drugs with similar function (collectively GLP-1s) have been used for type 2 diabetes mellitus and have been effective for obesity. Their profound effect on weight loss has resulted in widespread use of these medicines for treating obesity. Extensive studies have shown that GLP-1s decrease body weight, lean mass, and other metabolic phenotypes. These studies were supported by the mechanism of signaling pathways of GLP-1s in cells and their metabolic effects. Recently, studies have focused on the effect of GLP-1s on the brain, showing that they affect food cognition, depression, drug addiction, and even neurodegenerative diseases. Although recent studies have investigated the impact of GLP-1s on the brain, our understanding of these effects is limited. This review describes how GLP-1s have become the most effective drugs in obesity, such as their known signaling pathway in cells and their pharmaceutical processing over the years. This review covers recent discoveries of the GLP-1 mechanisms in the brain, including their prominent effects on obesity, and discusses discoveries that imply their potential usage in brain disorders.

Purpose: To assess disparities in children referred for short stature evaluation and to evaluate the effectiveness of physician interventions on referral rates.

Methods: Retrospective chart review was conducted on children referred to a pediatric endocrinology center for short stature evaluation between 1/1/2022 and 12/31/2023. Interventions for participating physicians included an educational lecture and electronic medical record alert. Six-month pre- and postintervention referral rates for short stature from a general pediatrics practice were assessed.

Results: There were 747 children (68% males) with a predominance of non-Hispanic White (NHW) children (64%). Females presented at a younger age (P<0.001), lower height (P<0.001), and a greater height deficit (P=0.002) than males. Hispanic children presented with greater height deficits than NHW and non-Hispanic Black (NHB) children (all P<0.05). In those with heights <-2 standard deviations (SDs) (n=192) from the mean, there were no significant sex differences; however, Hispanic children continued to have greater height deficit than NHW and NHB children (all P<0.02). There was no sex difference in those who underwent growth hormone stimulation testing (GHST); however, NHW children comprised the largest racial group. After implementing the interventions in the general pediatrics practice, short stature referral rates improved (15 of 118 referrals [13%] to 25 of 81 referrals [31%], P=0.002).

Conclusion: Disparities in overall short stature referrals were less evident in the subset of children with heights <-2 SD from mean. There was no significant sex bias in GHST, but racial/ethnic disparities remained. Improvement in referring and evaluating females and children from minority groups is still crucial as they remain under referred.